Hospital diabetes audit shows room for improvement

The number of patients with hospital acquired foot ulcers has been slashed by 50 percent thanks to the launch of the diabetes inpatient audit, show figures from the Health and Social Care Information Centre (HSCIC).

Only 1.1 percent of inpatients with diabetes developed a new foot lesion - a potentially devastating and costly preventable compilation of the disease - during their admission to hospital, a significant fall from 2.2 percent when inpatient auditing began back in 2010.

However, the data also shows that there is still much room for improvement, given that more than two thirds of inpatients included in the 2015 audit did not have a specific diabetic foot risk examination while in hospital, and 31 percent of hospital sites still do not have a multi-disciplinary diabetic foot care team.

Furthermore, the National the National Diabetes Inpatient Audit, which is carried out by the HSCIC, in collaboration with Diabetes UK, found no improvement in the other two main hospital inpatient harms - severe hypoglycaemic episodes and diabetic ketoacidosis.

While the proportion of inpatients having one or more hypoglycaemic episode since 2010 has fallen from 26.1 percent to 21.8 percent, there was no significant reduction in those having one or more severe life threatening hypoglycaemic episodes requiring emergency rescue with injectable treatment (2.4 percent in 2010 compared to 2.1 percent 2015).

The number of inpatients developing the severe life threatening and wholly preventable condition DKA after admission has also stayed level, at 0.4 percent in both 2010 and 2015.

The rising trend of the percentage of hospital beds occupied by people with diabetes continued, with 14.6 percent in 2010, 15.8 percent in 2013 and 16.8 percent in the 2015 audit and, while levels of referrals and patient contacts have increased amongst diabetes teams, there has been no corresponding significant increase in staffing levels, the report notes.

Medication errors riseThe Audit also revealed a turnaround in the decreasing trend for the number of medication errors reported for diabetic inpatients, which increased from 37 percent in 2013 to 38.8 percent. A review of inpatient drug charts also found that 23.9 per cent had at least one medication management error within the previous seven days, a significant increase from 22.3 percent in the prior audit, HSCIC said.

"We are proud of what the audit has achieved since 2010 and the difference it has made to hospital care for patients with diabetes. However the results do show that, while the number of inpatients continues to rise, this is not being matched by resources and staffing which could make an even more significant improvement," said audit lead clinician, Dr Gerry Rayman.

"The 50 percent reduction in hospital acquired foot ulcers since the introduction of NaDIA, on its own, equates to an estimated annual saving of over £30 million which would more than provide sufficient savings to fund the inpatient diabetes specialist teams that could help reduce the other harms. The achievements gained should be celebrated but there is still much more work to be done to reduce entirely preventable very serious treatment related complications."